TORONTO - The photos say it all: young children, three and four to a bed, black mould growing on a paper-thin wall near their heads. A tiny house, only a step or two up from a shack, a broken window half-covered by a board to keep the weather out.
Chief Alex Robinson tacked up the pictures from his community of Cross Lake in northern Manitoba in a meeting room of a Toronto hotel, where global health experts and aboriginal leaders gathered Thursday to craft a plan for cutting tuberculosis rates among indigenous peoples worldwide.
TB is a global scourge that affects almost two billion people - and about 370 million of them are from indigenous populations.
In Canada, rates among aboriginals are almost 30 times higher than that of non-aboriginals; for Inuit, the rate is a staggering 90 times higher, and experts agree that poverty is mostly to blame.
Robinson said more than 90 per cent of the adults in his community of 3,000 are unemployed.
Cross Lake recently had an outbreak of 19 cases of active, infectious TB, but it's unknown how many others carry a latent form of the bacteria.
Angus Toulouse, vice-chief for the Assembly of First Nations, agreed tuberculosis is a "disease of poverty."
"The best cure for poverty is employment," said Toulouse, who called on the federal government to invest in First Nation communities to improve economic opportunities and to increase social housing.
"We want sustainable solutions to control tuberculosis among First Nations," including improved access to health services and better education about the disease, especially among young people.
David Butler-Jones, chief public health officer for Canada, said the federal government has donated $30 million for the global fight against TB, which has a goal of halving cases worldwide by 2015 and eradicating the disease by 2050.
Health Canada spends about $6.5 million a year for tuberculosis prevention and control and $272 million to build or upgrade housing for aboriginal Canadians.
But he said solutions for dealing with the disease will need a collaborative effort that includes all levels of government, aboriginal organizations, communities and individuals.
"TB is not just a public health issue," he said. "It's a disease and a condition that requires a communal effort as we work to address both the disease and the underlying living conditions ... that contribute to its spread."
While tuberculosis is curable with combination drug therapy, the treatment can take about six months to fully destroy the bacteria.
Gail Turner, director of health services for Nunatsiavut, a regional Inuit government in Newfoundland and Labrador, said for many Inuit and other aboriginal people, treatment itself can be problematic.
"There's a tremendous challenge with compliance," said Turner, an Inuit registered nurse. "It's a long time to take medication, you've got to have blood tests done to see how your liver is doing. And that's often the piece that loses the individual, those blood tests."
And then there's the high rate of alcoholism, she said.
"Alcoholism is both a cause of deteriorating health that makes you more vulnerable to TB and it also challenges your ability to take your medication effectively."
